REINSTATEMENT OF DOCUMENTATION

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NOTE: FILING THIS APPLICATION DOES NOT ENTITLE A VESSEL TO DOCUMENTATION OR TO ANY CHANGES SOUGHT ON A CERTIFICATE OF DOCUMENTATION. OFFICIAL NUMBERS DESIGNATED ON THE BASIS OF THIS APPLICATION ARE NOT TRANSFERABLE. ONLY A CURRENT CERTIFICATE OF DOCUMENTATION IS VALID FOR VESSEL OPERATION.

IF YOUR USCG (CERTIFICATE OF DOCUMENTATION) HAS PASSED 30 DAYS OF EXPIRATION, YOU MUST REINSTATE YOUR DOCUMENTATION.

A.Vessel Name (Required)*

B. OFFICIAL NUMBER*

CONFIRM OFFICIAL NUMBER*

C. HULL ID # (IF ANY)

Insert Hull Identification Number (HIN) as assigned in accordance with 33 CFR 81.

D. IMO # (IF ANY)

Insert International Maritime Organization Number (IMO), if any.

E. HAILING PORT INCLUDING STATE

Insert the name of city and state exactly as it is marked on the vessel.

Name, e-mail address, and telephone number of the owner to whom the Coast Guard should send correspondence and their Social Security Number (SSN) or Tax Identification Number (TIN). Only an owner or co-owner can be the managing owner. For vessels owned by a corporation, the corporation is the managing owner. For a trust arrangement, the trust is the managing owner. For a Partnership or an LLC, the name of the Partnership or the LLC is the owner.

NAME OF MANAGING OWNER

IMPORTANT: ALL registered owners must be included. Please enter any additional owners in section H below.

J. CITIZENSHIP OF OWNER (CHECK THE BOX(ES) TO SHOW THE TYPE(S) OF ENTITY(IES) THAT OWNS THE VESSEL)Vessel must be owned by a U.S. citizen eligible for the
endorsement(s) sought. Select the section that describes the type of
entity that owns the vessel. Citizenship for all owners must be
provided.

INDIVIDUAL: Includes native born and naturalized U.S. citizens.

GOVERNMENT ENTITY: Includes Federal, State, Territory, Possession or Subdivision.

CORPORATION: Complete all items that apply.

LIMITED LIABILITY COMPANY (LLC): Complete Equity Section and choose type. For member managed LLC, a list of members is required. Click icon for attachment if application covers multiple members.

PARTNERSHIP: Complete Equity Section and choose type. A list of all general partners is required. Click icon for attachment if application covers multiple general partners.

CORPORATIONS QUALIFIED UNDER 46 CFR 68.01 OR OWNED BY A NOT-FOR-PROFIT OIL RECOVERY COOPERATIVE: Attach a copy of the Certificate of Compliance or Letter of Qualification issued by the Director, NVDC.

JOINT VENTURE/ASSOCIATION: A list of all joint venturers/members is required. The percentage held by each need not be shown. Click icon for attachment if application covers multiple joint venturers/members.

TRUST ARRANGEMENT: All trustees must be U.S. citizens. If applicable, each beneficiary with an enforceable interest must be a citizen. A list of all trustees (except managing owner) and beneficiaries with an enforceable interest is required. Click icon for attachment if application covers multiple trustees/beneficiaries with an enforceable interest.

ONE OR MORE INDIVIDUALS, I (WE) CERTIFY THAT ALL OWNERS OF THIS VESSEL ARE CITIZENS OF THE UNITED STATES

EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C).

LESS THAN 50%

75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)

75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)

50% OR MORE: (I)

List of All Joint Ventures/Members (First & Last Name(s)):

STATE EXACT PERCENTAGE

1. MEMBER MANAGED LIMITED LIABILITY COMPANY I (WE) CERTIFY THAT ALL MEMBERS OF THIS LLC ARE CITIZENS OF THE UNITED STATES ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.

LIST OF ALL MEMBERS (FIRST & LAST NAME(S)):

OR

2. LIMITED LIABILITY COMPANY NOT MANAGED BY MEMBERS AND NOT SIMILAR TO GENERAL PARTNERSHIP: PLEASE NOTE (A) & (B) MUST BE CHECKED FOR FISHERY AND COASTWISE ENDORSEMENTS; NOT REQUIRED FOR COASTWISE OIL SPILL OR COASTWISE UNDER CHARTER ENDORSEMENTS.

A. I (WE) CERTIFY THAT ANY PERSON ELECTED TO MANAGE THE LLC OR WHO IS AUTHORIZED TO BIND THE LLC, AND ANY PERSON WHO HOLDS A POSITION EQUIVALENT TO THE CHIEF EXECUTIVE OFFICER, BY WHATEVER TITLE, AND THE CHAIRMAN OF THE BOARD OF DIRECTORS IN A CORPORATION, AND ANY PERSONS AUTHORIZED TO ACT IN THEIR ABSENCE ARE CITIZENS OF THE UNITED STATES

B. NON-CITIZENS DO NOT HAVE AUTHORITY WITHIN A MANAGEMENT GROUP, WHETHER THROUGH VETO POWER, COMBINED VOTING, OR OTHERWISE, TO EXERCISE CONTROL OVER THE LLC

STATE WHERE ORGANIZED

PARTNERSHIP (COMPLETE EQUITY SECTION AND CHOOSE TYPE) (SEE SECTION M, ITEM 5 WHEN APPLYING FOR FISHERY OR COASTWISE ENDORSEMENT) EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C)

LESS THAN 50%

75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)

75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)

50% OR MORE: (I)

STATE EXACT PERCENTAGE

1. GENERAL PARTNERSHIPI (WE) CERTIFY THAT ALL PARTNERS IN THIS PARTNERSHIP ARE CITIZENS OF THE UNITED STATES ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.

2. LIMITED PARTNERSHIP I (WE) CERTIFY THAT ALL GENERAL PARTNERS IN THIS PARTNERSHIP ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.

LIST ALL GENERAL PARTNERS (REQUIRED)

TRUST ARRANGEMENT

I (WE) CERTIFY THAT ALL TRUSTEES AND ALL BENEFICIARIES WITH AN ENFORCEABLE INTEREST IN THIS TRUST ARRANGEMENT ARE CITIZENS OF THE UNITED STATES, ELIGIBLE TO DOCUMENT VESSELS WITH THE ENDORSEMENT(S) SOUGHT IN THEIR OWN RIGHT.

EQUITY INTEREST OWNED BY PERSONS ELIGIBLE TO DOCUMENT VESSELS IN THEIR OWN RIGHT WITH THE ENDORSEMENT(S) SOUGHT IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART C)

LESS THAN 50%

50% OR MORE: (I)

75% OR MORE (AND, AT EACH TIER, IF APPLICABLE)

75% OR MORE (AND, AT EACH TIER AND IN THE AGGREGATE (IF FISHERY), IF APPLICABLE)

LIST OF ALL TRUSTEES AND ALL BENEFICIARIES WITH AN ENFORCEABLE INTEREST (REQUIRED)

K. I (WE) CERTIFY THAT: (MARK ALL THAT ARE APPLICABLE. ITEM 5. NOT REQUIRED FOR COASTWISE BOWATER ONLY, OIL SPILL, OR UNDER CHARTER ENDORSEMENTS.)

Complete as appropriate. The law provides severe penalties for false statements against both the person (including agents) making the statement and against the vessel for which it is made.

1. I AM (WE ARE) A CITIZEN(S) OF THE UNITED STATES AND LEGALLY AUTHORIZED TO EXECUTE THIS APPLICATION IN THE CAPACITY SHOWN;

2. IN ACCORDANCE WITH 46 CFR PART 67 (SUBPART I) THE VESSEL(S) TO WHICH THIS APPLICATION APPLIES;

(a) HAS (HAVE) BEEN MARKED

WILL BE MARKED;

(b) WILL AT ALL TIMES REMAIN UNDER THE COMMAND OF A U.S. CITIZEN, UNLESS DOCUMENTED SOLELY WITH A RECREATIONAL ENDORSEMENT; WILL NOT BE OPERATED IN A TRADE NOT AUTHORIZED BY THE ENDORSEMENT(S) ON THE CERTIFICATE(S) OF DOCUMENTATION. THE NAME(S) OF THE VESSEL(S) WILL NOT BE CHANGED WITHOUT APPROVAL FROM THE NATIONAL VESSEL DOCUMENTATION CENTER; AND I (WE) WILL PROMPTLY NOTIFY THE NATIONAL VESSEL DOCUMENTATION CENTER UPON A CHANGE IN ANY OF THE INFORMATION OR REPRESENTATIONS IN THIS APPLICATION.

3. HAS (HAVE) NOT OR

3a. HAS (HAVE) BEEN REBUILT OR SUBSTANTIALLY ALTERED SINCE LAST DOCUMENTATION;

4. THE VESSEL IS (NOT TITLED UNDER A STATE OR TITLED UNDER THE LAWS OF [INPUT])

THE VESSEL IS

NOT TITLED UNDER A STATE (OR)

TITLED UNDER THE LAWS OF (INPUT BELOW)

TITLED UNDER THE LAWS OF:

THE FOLLOWING ITEM (5.) IS REQUIRED FOR COASTWISE AND/OR FISHERY ENDORSEMENTS; HOWEVER, IT IS NOT REQUIRED FOR COASTWISE BOWATER ONLY, OIL SPILL, OR UNDER CHARTER ENDORSEMENTS.

5. U.S. CONTROL CERTIFICATION: THERE IS NO CONTRACT OR UNDERSTANDING THAT PROVIDES MORE THAN 25% OF THE VOTING POWER IN THE PARTNERSHIP, LIMITED LIABILITY COMPANY, CORPORATION, OR OTHER OWNING ENTITY EITHER DIRECTLY OR INDIRECTLY ON BEHALF OF ANY PERSON NOT A CITIZEN OF THE UNITED STATES. BY NO MEANS WHATSOEVER IS CONTROL IN EXCESS OF 25% CONFERRED UPON OR PERMITTED TO BE EXERCISED BY A PERSON WHO IS NOT A CITIZEN OF THE UNITED STATES.

PRIVACY ACT STATEMENT IN ACCORDANCE WITH 5 U.S.C. 553a, THE FOLLOWING INFORMATION IS PROVIDED TO YOU WHEN SUPPLYING PERSONAL INFORMATION TO THE U.S. COAST GUARD. 1. AUTHORITY. SOLICITATION OF THIS INFORMATION IS AUTHORIZED BY 46 U.S.C., CHAPTERS 121 AND 125; 46 U.S.C. APP. 802 AND 883. 2. THE PRINCIPAL PURPOSES FOR WHICH THIS INFORMATION IS TO BE USED ARE: (1) TO DETERMINE CITIZENSHIP OF THE OWNER OF THE VESSEL FOR WHICH APPLICATION FOR DOCUMENTATION IS MADE; AND (2) TO DETERMINE ELIGIBILITY OF THE VESSEL TO BE DOCUMENTED WITH THE TRADE ENDORSEMENT SOUGHT. 3. THE ROUTINE USES WHICH MAY BE MADE OF THIS INFORMATION INCLUDE RELEASE TO LAW ENFORCEMENT OFFICIALS, TO THE GENERAL PUBLIC UNDER FREEDOM OF INFORMATION ACT, AND TO PUBLISH INFORMATION ABOUT U.S. DOCUMENTED VESSELS. 4. DISCLOSURE OF THE INFORMATION REQUESTED ON THIS FORM IS VOLUNTARY, HOWEVER, FAILURE TO PROVIDE THE INFORMATION REQUESTED WILL RESULT IN DENIAL OF THE APPLICATION FOR DOCUMENTATION, WHICH MAY PREVENT THE OWNER FROM OPERATING THE VESSEL(S) IN A SPECIFIED TRADE.

Please select any additional services you wish to add to have processed

Please note that all Abstracts of Title(s) will be processed at time of submission. To acquire an Abstract of Title to furnish proof of the completion of an application, or mortgage/instrument, please apply after the applicable application has been processed.

Priority Request/Rush Processing

Abstract of Title

Certified Copy of COD

Preferred Mortgage

Satisfaction of Mortgage

Based on your submission, the following service(s) are also required:

Coastwise Endorsement

Price:$29.00

Fishery Endorsement

Price:$12.00

PRIORITY REQUEST REQUEST / RUSH PROCESSING

Reason for Priority Request

I (we) understand that making a false statement when applying for vessel documentation may subject the vessel to seizure by and forfeiture to the United States Government (46 USC §12151, formerly 46 USC §12122).

GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES.

INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)

NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)

GRANTEE. FOR PURPOSES OF THIS FORM, GRANTEES
INCLUDE MORTGAGEES, ASSIGNEES, PERSON FROM WHOM MORTGAGES ARE ASSUMED, AND PERSON TO WHOM SUBORDINATION OF MORTGAGES ARE GRANTED. LIST ALL GRANTEES AND ADDRESSES.

INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)

GRANTOR. FOR PURPOSES OF THIS FORM, GRANTORS INCLUDE MORTGAGORS, ASSIGNORS, PERSONS ASSUMING MORTGAGES, PERSONS GRANTING SUBORDINATION OF MORTGAGES. LIST ALL GRANTORS AND ADDRESSES.

INTEREST OWNED IN VESSEL OR HELD IN MORTGAGE AFFECTED BY ATTACHED INSTRUMENT (100% UNLESS OTHERWISE STATED)

NAME(S) AND ADDRESS(ES) OF GRANTEE(S) (MORTGAGEE(S), ASSIGNEE(S), OR OTHER(S)

GRANTEE. FOR PURPOSES OF THIS FORM, GRANTEES
INCLUDE MORTGAGEES, ASSIGNEES, PERSON FROM WHOM
MORTGAGES ARE ASSUMED, AND PERSON TO WHOM
SUBORDINATION OF MORTGAGES ARE GRANTED. LIST ALL
GRANTEES AND ADDRESSES.

IF THE FOLLOWING INFORMATION IS UNKNOWN YOU MUST ORDER AN ABSTRACT OF TITLE UNDER ADDITIONAL SERVICES TOWARDS THE TOP OF THE PAGE.

RECORDED BOOK:

Page

FILE/RECORDED DATE:

Date Format: MM slash DD slash YYYY

TIME:

OTHER IDENTIFYING DATA:

USCG RENEWAL DOCUMENTATION ADVANCED PAYMENT OPTION

NOTE: Your yearly certificate will be valid for one year only. You will receive one (1) Year long certificate each year, depending on how many additional years you have ordered. For each individual year of renewal, a new renewal will be AUTOMATICALLY forwarded to your designated address at the time of renewal(s). This may require that the vessel owner update their current address to facilitate the renewal process.

1 year renewal (additional $75.00)

2 year renewal (additional $150.00)

3 year renewal (additional $225.00)

4 year renewal (additional $300.00)

5 year renewal (additional $375.00)

Total

$0.00

Authorization*

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected USCG documents. I understand that my application will be processed in the order in which it is received by Vessel Documentation Online, LLC, a private fee for service documentation company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Vessel Documentation Online, LLC's no refund policy and as per 46 CFR 67.500(e). I understand information provided in this online fillable form will be utilized for the completion of form CG-1258 for COD Reinstatement.

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